Provider Demographics
NPI:1053370163
Name:RANNIN, BRUCE ALAN (DMD)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:ALAN
Last Name:RANNIN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:764 CHANDLER RD
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-3130
Mailing Address - Country:US
Mailing Address - Phone:630-244-4993
Mailing Address - Fax:
Practice Address - Street 1:3001A SIXTH STREET
Practice Address - Street 2:NAVAL HOSPITAL N00211
Practice Address - City:GREAT LAKES
Practice Address - State:IL
Practice Address - Zip Code:60088
Practice Address - Country:US
Practice Address - Phone:847-688-3950
Practice Address - Fax:847-688-6369
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist